fa شناسایی عوامل مرتبط با بقای بیماران مبتلا به لوسمی با استفاده از اسپلاین های جریمه شده و مقایسه آن با مدل خطرات متناسب کاکس آمار زیستی Biostatistics پژوهشي-کامل Research(Original) <span style="font-size:11pt"><span style="line-height:normal"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><b><span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">&nbsp;</span></span></b></span></span></span></span></span><span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:92%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="FA" style="line-height:92%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.2pt">سابقه</span></span></span></span><span lang="AR-SA" style="line-height:92%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.2pt"> و هدف:</span></span></span></span> <span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">سرطان خون یکی از بیماری</span></span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">‌</span></span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">های شایع و کشنده است، که از جمله مهم</span></span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">‌</span></span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">ترین مشکلات بهداشتی و سلامت در جامعه می</span></span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">‌</span></span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">باشد. </span></span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">هدف از انجام این مطالعه بررسی بقای بیماران مبتلا به لوسمی </span></span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">لنفوبلاستیک</span></span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt"> حاد</span></span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">(</span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:92%"><span style="letter-spacing:-.2pt">ALL</span></span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">) و لوسمی</span></span></span> <span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">میلوبلاستیک حاد</span></span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">(</span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:92%"><span style="letter-spacing:-.2pt">AML</span></span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">) با استفاده از مدل اسپلاین</span></span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">‌</span></span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">های جریمه شده</span></span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt"> و مقایسه آن با مدل خطرات متناسب کاکس است</span></span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">.<span style="color:#0e101a"></span></span></span></span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:92%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="line-height:92%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.1pt">مواد و روش</span></span></span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.1pt">‌</span></span></span></span><span lang="AR-SA" style="line-height:92%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.1pt">ها:</span></span></span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">در<b> </b>این مطالعه کوهورت گذشته نگر، از اطلاعات بیماران مبتلا به لوسمی حاد مراجعه کننده به بیمارستان امام خمینی تهران استفاده شد. بیماران طی سال</span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar="">‌</span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">های 1390 تا 1393 وارد مطالعه شدند و تا سال 95 مورد پیگیری قرار گرفتند.</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">اطلاعات بیماران به</span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar="">‌</span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">صورت سرشماری، توسط یک چک لیست محقق ساخته از پرونده</span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">‌</span></span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">های آن</span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar="">‌</span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">ها جمع</span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar="">‌</span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">آوری گردید و آخرین وضعیت بیماران با تماس تلفنی تکمیل شد. بررسی بقای پنج ساله بیماران با روش ناپارامتری کاپلان مایر و تعیین عوامل خطر در زیرگروه</span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">‌</span></span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">ها با استفاده از مدل نیمه پارامتری کاکس انجام شد. پس از آن برازش مدل رگرسیونی اسپلاین جریمه شده با نرم</span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar="">‌</span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">افزار </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:92%">R</span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar=""> نسخه 4/2/2 انجام شد.<span style="color:black"></span></span></span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:92%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="line-height:92%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.2pt">یافته</span></span></span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.2pt">‌</span></span></span></span><span lang="AR-SA" style="line-height:92%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.2pt">ها:</span></span></span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">میانگین سنی بیماران 16/01</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:92%">&plusmn;</span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">36/29 سال بود و<b> </b>36/7</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">درصد</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">از</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">بیماران</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">مرد</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">بودند. 50</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">درصد بیماران فوت شده و</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">12/7</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">درصد</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">عود داشتند.</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">34/7</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">درصد</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">از</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">بیماران</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">دارای</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">لوسمی لنفوبلاستیک</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">حاد</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">و</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">63/3 درصد مبتلا به </span></span>&nbsp;<span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">لوسمی میلوبلاستیک حاد</span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">بودند. بقای پنج ساله بیماران مبتلا به </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:92%">ALL</span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar=""> و </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:92%">AML</span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar=""> به ترتیب 18 و 29 درصد بود. سن بیماران، تعداد گلبول</span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">‌</span></span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">های سفید، پلاکت و هموگلوبین خون با بقای بیماران ارتباط معنی داری داشت(0/05</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:92%"><span b="" style="font-family:" zar="">></span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:92%">P</span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">).<span style="color:black"></span></span></span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:92%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="line-height:92%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.2pt">استنتاج:</span></span></span></span> <span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">سن ابتلا به لوسمی در کشور ایران پایین است و با توجه به اهمیت سن در بقای بیماران مبتلا به آن، تشخیص و اقدام به درمان زود هنگام این بیماری می</span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">‌</span></span></span><span lang="FA" style="line-height:92%"><span b="" style="font-family:" zar="">تواند در بهبود بقای این بیماران نقش به سزایی داشته باشد<b>.</b></span></span><span lang="AR-SA" style="line-height:92%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.2pt"></span></span></span></span></span></span></span></span></span></span></span><br> &nbsp; <span style="font-size:11pt"><span style="line-height:normal"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">&nbsp;</span></span></b></span></span></span></span><span style="font-size:12pt"><span style="line-height:130%"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:130%"><span arial="" style="font-family:"><span style="letter-spacing:-.2pt">Background and purpose:</span></span></span></span></b> <span style="font-size:10.0pt"><span style="line-height:130%">Leukemia is one of the most common and deadly diseases which is an important health problem.</span></span> <span style="font-size:10.0pt"><span style="line-height:130%">The aim of this study was to evaluate the survival of patients with acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML) using the penalized splines model and comparing that with the Cox proportional hazards model.</span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:130%"><span style="text-autospace:none"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:130%"><span arial="" style="font-family:">Materials and methods:</span></span></span></b><b> </b><span style="font-size:10.0pt"><span style="line-height:130%">This is a longitudinal survival research that used data from patients referred to Tehran Imam Khomeini Hospital between 2011 and 2014 and followed until 2016. Patients&#39; information was collected through census, using a researcher-made checklist based on their files. Furthermore, the patients&#39; latest status was obtained via phone calls. All medical records of the patients referred to Amir Al-Momenin hospital in Maragheh and diagnosed with prostate hyperplasia and underwent prostatectomy between 2014 and 2019 were examined taking a census. Kaplan-Meier nonparametric method was used to assess the 5-year survival rate, and Cox&#39;s semiparametric model was used to determine the risk factors in subgroups. Then, the penalized spline regression model was fitted using the R software version 4.2.2.</span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:130%"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:130%"><span arial="" style="font-family:">Results:</span></span></span></b><b> </b><span style="font-size:10.0pt"><span style="line-height:130%">The average age of patients was 36.29&plusmn;16.01 and 36.7% of the patients were men. Half of the patients died, and 12.7% experienced recurrence. Acute lymphoblastic leukemia affected 34.7% of the patients, whereas acute myeloblastic leukemia affected 63.3%. The 5-year-survival rates for patients with ALL and AML were 18% and 29%, respectively. Age, white blood cell count, platelet count, and hemoglobin levels were found to be significantly associated with patients&#39; survival (P<0.05).</span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:130%"><span style="vertical-align:top"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:130%"><span arial="" style="font-family:">Conclusion:</span></span></span></b><span style="font-size:10.0pt"><span style="line-height:130%"> Leukemia is seen at young ages in Iran, so, early detection and treatment of the disease can play a critical role in improving the survival of patients.<i></i></span></span></span></span></span></span><br> &nbsp; لوسمی, تحلیل بقا, لوسمی میلوییدی حاد, لوسمی لنفوسیتی حاد leukemia, survival analysis, acute lymphocytic leukemia, acute myeloid leukemia 44 55 http://jmums.mazums.ac.ir/browse.php?a_code=A-10-7716-2&slc_lang=fa&sid=1 Afsaneh Fendereski افسانه فندرسکی afsaneh.fendereski@gmail.com 1003194753284600155987 1003194753284600155987 No Assistant Professor, Department of Biostatistics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran استادیار، گروه آمار زیستی، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران Jamshid Yazdani Charati جمشید یزدانی چراتی jamshid.charati@gmail.com 1003194753284600155988 1003194753284600155988 Yes Professor, Department of Biostatistics, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran استاد، گروه آمار زیستی، مرکز تحقیقات علوم بهداشت، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران Sayyed Reza Safaee Nodehi سید رضا صفائی نودهی safano1339@gmail.com 1003194753284600155989 1003194753284600155989 No Assistant Professor, Department of Internal Medicine, Cancer Research Centre, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran استادیار، گروه داخلی، مرکز تحقیقات سرطان، دانشکده پزشکی، دانشگاه علوم پزشکی تهران، تهران، ایران Reza Ali Mohammadpour Tahamtan رضاعلی محمدپور تهمتن rezaali.mohammadpour@mazums.ac.ir 1003194753284600155990 1003194753284600155990 No Professor, Department of Biostatistics, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran استاد، گروه آمار زیستی، مرکز تحقیقات علوم بهداشت، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران